Traumatic spinal cord injury-Myotome-Dermatomes

Created by Glorygrace 

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L1-L2 Myotome

Hip flexors

L3 myotome

Knee extensor

L4 myotome

Ankle dorsiflexors

L5 myotome

Great toe extensors
Knee flexors
Hip extensors

S2 myotome

Toe and knee flexors

C1-2 myotome

Cervical spine flexors

C3 myotome

Cervical spine lateral flexors

C4 myotome

Scapular elevators

C5 myotome

Shoulder abductors

C6 myotome

Elbow flexors and wrist extensors

C7 myotome

Elbow extensors and wrist flexors

C8 myotome

Thumb extensors

T1 myotome

Hand intrinsics (ulnar)

C3 dermatome

Neck

C4 dermatome

Sternum

C5 dermatome

Anterolateral of shoulder

C6 dermatome

Thumb

C7 dermatome

Middle finger

C8 dermatome

Little finger

T1 medial arm

Medial arm

T4 dermatome

Nipple

T10 dermatome

Navel

T12 dermatome

Pubis

L1 dermatome

Groin

L2 dermatome

Medial thigh

L3 dermatome

Medial knee, anterior thigh

L4 dermatome

Medial ankle and great toe, patella

L5 dermatome

Dorsum of foot

S1 dermatome

Lateral foot

S2 dermatome

Plantar surface of foot

S3,4,5 dermatome

Plantar surface of foot

C1-C3 nerve rt

Face and neck muscles (cranial innervation)
Talking
Masticating
Sipping
Blowing

C4 nerve rt

Diaphragm, trapezius
Respiration
Scapulae elevation

C5 nerve rt

Biceps, brachialis, brachioradialis, deltoid, infraspinatus, rhomboid and supinator
Elbow flexion and supination
Shoulder external rotation
Shoulder abduction to 90
Limited shoulder flexion

C6 nerve rt

ECR, infraspinatus, latissimus dorsi, pectoralis major, pronator teres, serratus anterior and teres minor
Shoulder flexion, extension, IR, and abd
Scapulae abd and UR
Forearm pronation
Wrist extension

C7 nerve rt

EPL & EPB, extrinsic finger extensors, FCR, triceps
elbow extension
wrist flexion
finger extension

C8-T1 nerve rt

extrinsic finger flexors, FCU, FPL & FPB, intrinsic finger flexor
full innervation of UE mm including fine coordination and strong grasp

T4-T6 nerve rt

top half of intercostals, long mm of the back (semispinalis)
improved trunk control
increased respiratory reserve
pectoral girdle stabilization for lifting objects

T9-T12 nerve rt

lower abdominals, all intercostals
improved trunk control
increased endurance

L2-L4 nerve rt

gracilis, iliopsoas, quadratus lumborum, rectus femoris, sartorious
hip flexion
hip adduction
knee extension

L4-L5 nerve rt

extensor digitorum, low back mm, medial hamstrings, post. tibialis, quadriceps, tibialis anterior

Nontraumatic SCI

vascular malformation
vertebral subluxation
infection (meningitis)
neoplasms (tumors)
syringomyelia
abscesses
MS
ALS
hysterical paralysis

traumatic SCI

MVA 46%
Falls !9%
acts of violence 18%
recreational sports 11%
other

SCI demographic variables

82% young men
56% btw 16-30
56% white
29% african american
9% hispanic

how much is the financial impact in one yr for a tetraplegic

$440k-$682k

financial impact on a paraplegic

$249k

what is SCI

trauma to the spinal cord causing partial or complete disruption of the nerve tracts and neurons

ranges of a SCI injury

contusion, laceration or compression of the cord

what happens if there is spinal cord edema

necrosis of the spinal cord can develop as a result of comprised capillary circulation and venous return

what may result from a SCI

loss of motor function, sensation, reflex activity, and bowel and bladder control may result

tetraplegia is a result of

lesions from C1-C8

functional characteristics of a tetraplegia

paralysis of all 4 extremities and trunk including respiratory mm

paraplegia is due to

lesions resulting from T1-S1

functional characteristics of paraplegia

partial or complete paralysis of all or part of the trunk and BLE

in designating the level of the lesions, normal means

3+/5 or Fair+
functional

complete lesions

no sensory or motor function below level of lesion
complete transection, severe compression, extensive vascular impairment to cord

incomplete lesions

preservation of some sensory or motor function below level of lesion
pressure on cord, swelling, partial transection of cord

clinical pictures of incomplete lesions

unpredictable
variable patterns of recovery
early return of function= good prognostic sign

what is a complete transection of the cord

SC is completely severed with total loss of sensation, movement, and reflex activity below the level of injury

what is a partial transection of the cord

the spinal cord is partially damaged or severed
symptoms depend on the extent and location of the damage

C2-C3 injury is usually

fatal

lesion above C4 causes

respiratory difficulty and paralysis of all four extremities

diaphragm is innervated by

C3-C5

can a pt w/C3 lesion breath well and why

no because of it's innervation has been affected

a thoracic level lesion causes

loss of control/movement of the chest, trunk, bowel, bladder, and legs, depending on the level of injury and completeness of injury

autonomic dysreflexia often occurs with

lesions above T6 and cervical lesions

etiology and symptoms of autonomic dysreflexia

visceral distention from a distented bladder, or impacted rectum
may cause sweating, bradycardia, hypertension, nasal stuffiness, and gooseflesh

lumbar and sacral nerve injury

cauda equina has the ability to regenerate
usually incomplete
loss of movement and sensation to the LE
often exhibit root escape- the preservation or return of function of nerve rts at or near the level of the lesion

vertabrae most frequently involved in SCI are

C5,6, and 7
T12
L1,2
occur mainly at junctions

what is an anterior cord syndrome

damage to the anterior portion of the cord, usually secondary to a flexion injury to C spine

characteristics of anterior cord syndrome

motor function and pain (CS tract), temperature and sensation (ST tract) are lost below the level of injury

what is a posterior cord injury

damage to the posterior portion of the cord

characteristics of posterior cord injury

loss of proprioception, stereognosis, 2pt discrimination, vibration, and graphaesthesia (dorsal columns)

central cord syndrome

occurs from a lesion in the central portion of the SC and often result from hyperextension injuries
cervical tract are located here

characteristics of central cord syndrome

more pronouced loss of motor function in the UE
varying degrees and patterns of sensation remain intact

Brown-Sequard sydrome

results from penetrating injuries that cause hemisection of the spinal cord or injuries that affect half of the cord
ex. gunshot or stab wounds

characteristics of Brown-Sequard syndrome

motor function, proprioception, vibration, and deep touch are lost on the same side of the body as the lesion.
sensations of pain, temperature, and light touch are lost on the opposite side of the body/lesion.

describe sacral sparing

an imcomplete lesion where the most centrally located sacral tracts are spared
often 1st sign of incomplete cervical lesion

what are the clinical signs of sacral sparing

perianal sensation
rectal sphincter contraction
cutaneous sansation in the saddle area
active contraction of toe flexors (S2)

example of flexion injury

head-on collision
blow to back of head or trunk

a flexion injury will result in an _______________ syndrome

anterior cord

example of compression injury

vertical or axial blow to the head
associated with flexion injury

example of hyperextension injury

strong posterior force such as rear-end collision
falls wiht chin hitting stationary object

a hyperextension injury will result in a _________________ syndrome

central cord syndrome

example flexion-rotation injury

posteior to anterior force directed at rotated vertebral column, rear end collision with passenger rotated toward driver

describe shearing mechanism of injury

occurs when a horizontal force is applied to the spine relative to the adjacent segments
disrupts ligaments
associated with fracture dislocations of the thoracolumbar region

describe distraction mechanism of injury

involves a traction force
the least common mechanism
occurs when significant momentum of the head is created (whiplash injuries)
momentum creates a tensile force in the cervical spine as the head is pulled away from the body

what are the clinical manifestations of SCI

spinal shock
motor and sensory impairments
impaired temperature control
respiratory impairment
bowel and bladder dysfunction
sexual dysfunction

describe spinal shock (neurogenic shock)

a sudden depression of reflex activity in the spinal cord below the level of injury (areflexia)
the mm become completely paralyzed and flaccid, sensation is lost , and reflexes are absent

spinal shock occurs

within the first hour of injury and can last hours to weeks
usually subsides w/i 24 hrs

when does spinal shock end

when the reflexes are regained

impaired temperature control occurs due to

the hypothalamus is unable to control cutaneous blood flow or level of sweating

what happens when the temperature control is impaired

the body is unable to shiver, vasodilate/vasoconstrict in response to heat/cold
decreased sweating below lesion level and diaphoresis above

respiratory impairment depends on

the level of lesion

key respiration mm are

diaphragm
intercostal
abdominals

name indirect impairments in a SCI

pressure ulcers
autonomic dysreflexia
postural hypotension
heterotopic ossification
contractures
DVT
pain
osteoporosis
renal calculi

how can you prevent pressure ulcers

cushion for p relief
pneumatic beds
turn q2h
pressure relief
avoid activities that tend to cause skin damage

what causes autonomic dysreflexia

caused by visceral distention from a distented bladder or impacted rectum
generally occurs after the period of spinal shock is resolved
occurs w/lesions above T6 and in cervical lesions

what are the signs and symptoms of autonomic dysreflexia

hypertension
bradycardia
flushing of the face and neck
SEVERE THROBBING HEADACHE
nasal stuffiness
piloerection
sweating
nausea
restlessness
dilated pupils and blurred vision

what is a trendelenburg position

supine in bed w/leg elevated

what can I do if a pt continues to have postural hypotension while seated

try to elevate blood pressure
move UE (AROM)
use ACE bandage above TED hose on LE to increase BP
elevate BLE
check abdominal binder
recline or tilt w/c
perform effleurage

what can I do if a pt is experiencing symptoms of autonomic dysreflexia

sit pt if lying down
loose tight clothing
check for kinks in catheter if present
ask for bowel program
check skin for cuts or bruises

what are cervical traction used for

used to stabilize fx or dislocations of the cervical or upper thoracic spine
Ex.skull tongs, halo traction

what should you monitor on a pt with a HALO traction

should monitor the client's neurological status for changes in movement or decreased strength
assess for tightness of the jacket by ensuring that one finger can be placed under the jacket

implementation for thoracic and lumbar/sacralinjuries

bedrest
immobilization with a fiberglass or body cast
use of brace or corset when the pt is out of bed

surgical implementation for thoracic and lumbar/sacral injuries

decompressive laminectomy
spinal fusion and Harrington Rod insertion

decompressive laminectomy

removal of one or more laminae
allows for cord expansion
performed if conventional methods fail to prevent neurological deterioration

spinal fusion and Harrington Rods

used for thoracic spinal injuries
insertion of metal or steel rod to stabilize the thoracic spine

medications for SCI

dexamethasone-anti-inflammatory and edema reducer
dextran- plasma expander, used to increase capillary blood flow within the spinal vord and to prevent or treat hypotension
dantrolene/baclofen- used for clients with UMN injuries, controls mm spasticity

name physical therapy interventions for SCI

respiratory management
ROM and positioning
selective strengthning/stretching- Ex.tight add, HS
orientation to vertical- to avoid ortho hypo
functional training- bed mobility
T/F
rolling
sitting
quadriped
kneeling
mobility training- W/C, and/orambulation

respiratory management

diaphragmatic breathing exs

T/F

sliding board
boost transfers
hoyer lift

sitting balance

supported static sitting balance using upside down chair and wedge
supported dynamic balance reaching cones or touching objects out of base of support
unsupported sitting balance edge of mat static or dynamic throwing/catching ball, hitting balloon

bed mobility

management of BLE onto mat using leg straps if appropriate
rolling
prone for pressure relief and hip flexor stretch

circle/ring sitting

adductor stretch
aids in donning socks and ADLs

long sitting

HS stretch
aids in ADLs

tilt table and standing frame

upright accomodation
BLE wt bearing for bone strength

UE strengthning

AROM/AAROM
shoulder stabs exs
UBE bike for cardio
UE strengthnin w/cuffs wts, wt machines
tricep pushups for strengthning and needed for pressure relief

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